Organization
MCRH ALPHA MEDICAL, P.A.
Active
Parent organization
THE MIDWEST CENTER FOR REPRODUCTIVE HEALTH, P.A.
Organization subpart
Yes
Provider details
NPI number
Legal business name
THE MIDWEST CENTER FOR REPRODUCTIVE HEALTH, P.A.
Authorized official
LARAMIE ANDERSON (BUSINESS OFFICE MANAGER)
(763) 494-7734
Entity
Organization
Contact information
Practice address
12000 ELM CREEK BLVD N, SUITE 350, MAPLE GROVE, MN 55369-7073
(763) 494-7700
(763) 494-7706
Mailing address
12000 ELM CREEK BLVD N, SUITE 350, MAPLE GROVE, MN 55369-7073
(763) 494-7700
(763) 494-7706
Taxonomy
Speciality
Code
Description
License number
State
207VE0102X
Reproductive Endocrinology Physician
Primary
33043
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3D491MI
BCBCMN PROVIDER FACILITY
MN
01
—
3D492
BCBSMN PROVIDER
MN
01
—
E02458
UPIN
MN
Enumeration date
09/16/2009
Last updated
09/16/2009
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